How fibre could save your life

At the age of 17, Andrew Crockett had every reason to believe that his body was betraying him. That was when the then-grade-12 student’s immune system went haywire, unleashing a blizzard of inflammatory molecules that seared his intestines, sapped his energy, lopped 15 kilograms off his frame and turned his poo to blood. His body was like an anxious tower guard spraying bullets at invading forces. The trouble was, there were no intruders; Crockett’s body was at war with itself.

“You hate your body, don’t you?” said Crockett’s mate, pointing out what had become increasingly apparent to friends and family, one day back in 2004, 10 years after his diagnosis. Crockett thought about it for a moment. “Yeah, I do,” he replied. “Because it causes me pain every day.”

Crockett, now a 35-year-old Byron Bay writer, suffers from an autoimmune condition called Crohn’s Disease. He’s currently in remission, but it’s taken him a long time to come to terms with the years he lost while at the mercy of the disease. Even now he still spends some days chained to the dunny, or is so low on energy he can barely drag himself out of bed. But on good days he plays golf, surfs and writes, the latest of his three books being the self-help title Acumen.

When the disease is active? It’s kind of like torture, reckons Crockett. “You’ve got raging ulcerations in your intestine and you’re in a world of pain,” he explains. “You’re bleeding, haemorrhaging, losing weight, malnourished. You could have a bowel obstruction at any moment and you’re on and off a drip.” When it got really bad, no amount of morphine could ease the pain. When it got worse, he had to have portions of his intestines cut out to enable him to eat again.

With 70,000 people suffering Crohn’s in Australia, Crockett’s immune system is statistically something of an outlier. But as evidence begins to mount that modern life, in particular what we put into our mouths, could be triggering similar, albeit less acute, immune responses in many of us, internal anarchy is something we all need to worry about.

That’s not good. Why? Because inflammation – the immune system’s primary defence mechanism against invaders – could be the underlying cause behind a whole raft of chronic diseases. And if you get one of these, it’s a fair bet that you’ll be the one that winds up hating your body.

YOU'VE PROBABLY had a paper cut or two in your time. Within minutes, your immune system springs into action, causing the injured skin to erupt in redness. Similarly, when you get a virus, a wave of inflammatory molecules are shuttled to the site of infection. Once the threat has been dealt with, the inflammatory molecules recede. At least they should.

The trouble begins when that system is continually turned on in a permanent, low-grade response. It may not wreak the immediate havoc on your internal organs that an autoimmune disease does, but as the years pass it begins to rot your insides, bit by inexorable bit.

Only discovered in 1993, chronic inflammation is now being implicated in everything from cardiovascular disease and type 2 diabetes, to cancer. The only other condition with that kind of rap sheet is obesity, to which inflammation appears to be intrinsically linked.

“All the chronic diseases that we may develop as we age are associated with chronic inflammation,” says Dr John Dixon, an associate professor at Baker IDI Heart and Diabetes Institute in Melbourne. “It provides that common link that was previously overlooked.”

What’s flicking the inflammatory switch? While it’s still early days, researchers have been lining up a slew of suspects – excessive hygiene, pollution – but many point their finger at diet, specifically processed foods and saturated fat.

Professor Leonard Storlien, from the University of Sydney’s Boden Institute of Obesity, Nutrition, Exercise and Eating, has been monitoring lab mice to track the inflammatory impact of a high-fat diet. Not only do the mice’s guts become inflamed, but the fat around their gut and their large intestine gets particularly so, says Storlien. “It seems like there’s a really strong gradient of inflammation of the gut outwards,” he says.

Why is an inflamed gut of such concern? For about 100 trillion reasons. That’s the approximate population of the colony of bacteria, both good and bad, living in symbiotic harmony in your gut.

The idea that a 1.5kg mass of microbes is residing in your tummy might be hard to, er, stomach. Even less palatable? With this internal empire comprising up to 70 per cent of your immune system, how you treat it could be a crucial factor in whether or not you get a chronic disease.

“The gut microbiota can be considered an extension of the self. Together with the genetic make-up, it determines the physiology of an organism,” says Professor Charles Mackay, from the Department of Immunology at Monash University. “Whether or not you have a healthy make-up of gut microbes can have serious consequences for your health. If it’s out of whack, you’re much more likely to develop inflammatory or autoimmune diseases.”

A growing army of researchers believe that elements of the Western diet – namely fat, refined carbs and processed foods – cause the gut wall to become more permeable, increasing the possibility of toxic substances, or even bacteria themselves, entering the bloodstream and setting off an inappropriate immune response.

The problem is – whether you like fast food or fine dining – processed, high-fat foods are hard to avoid. From the humble hamburger to succulent cuts of wagyu beef, we’re getting further and further away from the diet that sustained our prehistoric ancestors – and our bodies are struggling to keep up with the changes.

IN 2009, researcher Dr Garry Egger, a professor of lifestyle medicine at Southern Cross University, measured the inflammatory markers of subjects who ate 100 grams of either kangaroo or wagyu beef, two hours after fasting. Two weeks later, the subjects swapped to eat the other meal and the results were compared. The wagyu set off an immune response, the kangaroo did not.

“Kangaroo is one of the oldest forms of meat around,” says Egger. “It’s low in saturated fat and high in monounsaturated fat. Wagyu is a newly hybridised form of beef that’s both high saturated and high mono, so that it melts in your mouth.” While producers of wagyu promote its high levels of heart-healthy monounsaturated fat, it’s the ratio that’s important. “If it’s still high in saturated fat you’ve negated the mono,” says Egger.

The results support a broader hypothesis that “human interference” and indeed, modern life itself, are fuelling chronic inflammation, says Egger. “The things that cause inflammation are all relatively new to human beings, occurring in the 200 years since the industrial revolution,” he says, citing processed foods, sedentary lifestyles and stress as factors.

Even more worryingly, we may be on something of an inflammatory upswing, with changes in food and lifestyle in the past 30 years, or what Dixon calls an “IT or screen age”, accelerating the rise of chronic diseases. “We’ve seen a 30-year revolution and, in that time, obesity has arrived,” he says. “In developing societies, it’s beginning to occur now.”

Thirty years is a long time for a marriage. In terms of a species being able to adapt to changes in its environment and diet, though, it’s the blink of an eye. Foods like wine, beer, cocoa, chocolate and tea, which have been around for hundreds, even thousands of years, produce a relatively low inflammatory response, Dixon points out. “You would expect any organism to adapt to their environment, but genetically it’s a very slow process and the environment can change quickly.”

So how do you tell if your immune system is permanently stuck on a code orange? While weight is obviously a big factor, the equation is not as simple as you might imagine. At least one-third of people who are obese don’t get chronic diseases, while one-quarter of lean people do get metabolic conditions, says Egger.

It turns out it’s not how big you are, but where you hold the weight. “Someone with inflammation wears their weight centrally,” says Dixon. “They tend to have sedentary, high-pressure occupations. The classic example is middle managers, who have a lot of stress, poor sleep and they’re not focused on physical activity, nor on the quality of the food they consume.” Sound like anyone you know?

If processed, fatty foods are indeed the main dietary trigger, the question then arises: is there an off switch? There are three nutrients that may be able to play the role of nutritional putty to help reinforce your gut lining, says Mackay. The first is fibre, which gut microbes break down to produce short-chain fatty acids. These are recognised and then bound by the gut’s GPR43 receptor. “We think this is one of the most fundamental pathways for good gut integrity and proper immune balance,” says Mackay.

Communities that consume adequate amounts of fibre have a lower incidence of inflammatory disease, Mackay continues, adding that in some African tribes there is an almost complete absence of allergies or autoimmune diseases. Australians currently consume around 18-25g of fibre daily. You should increase that to at least 30-40g (see box “Rough Love”, below), recommends Mackay.

FIBRE'S CLOSE cousin, resistant starch – found in foods like grains, legumes and bananas – is another effective agent in producing short-chain fatty acids and promoting good bacteria in the gut, says Storlien. As the name suggests, these starches resist digestion, passing through the intestines intact.

Finally, you should also load up on fish oil. The ongoing Blue Mountains Eye study found omega 3s reduce risk of inflammation by 44 per cent. Greenland Eskimos survive largely on whale blubber and fish, and have some of the lowest rates of inflammation in the world. “They have very high cholesterol, but they don’t get cardiovascular disease and they don’t get autoimmune disease or asthma,” says Mackay.

Aside from nutrients, your other possible pathway to good gut health is probiotics, found in yoghurts and supplements. A 1996 study published in the Annals of Nutrition & Metabolism found that probiotic bacteria can stabilise the gut lining by reducing the production of inflammatory proteins. But the issue remains that many of these bugs don’t always survive in your stomach long enough to do any good.

“Probiotics have a chequered history full of charlatans and false claims,” says Storlien. “As we begin to understand the gut better, we can start targeting much more directly the kinds of dietary changes that can rebalance the microbiota profile.”

Related link: Are probiotics worth it?

Until then, you may be best to follow the example of the bloke whose immune system is more trigger-happy than yours is ever likely to be. After his mate called him out on his attitude to his body, Crockett began to come to terms with his condition. These days he often cradles his tummy, rubbing it like an expectant mother. He also practises deep-breathing techniques, in which he sucks air deep into his diaphragm. “It’s like giving your gut an internal massage,” he says.

Perhaps, most importantly, he’s changed his lifestyle. “When you get to a point where nothing is making you better and the drugs don’t work, you have to look at yourself and accept that there are things you can do to help.”

As a result, he steers clear of foods that he knows will cause him strife, such as fatty, processed foods, as well as gluten and dairy. Fish and vegies are now his staples and he’s become “a big believer in fibre”, loading up on salads and supplementing his diet with psyllium husk and Metamucil. In short, he’s learnt that the best way to look after your body is to love it.

Testing time

Currently, the primary method to measure inflammation is the C-reactive protein blood test, which charts the rise in CRP produced by the liver whenever there’s inflammation in the body. The test, however, is not routine, but rather a second tier measure your GP may advise if other tests, like cholesterol and blood pressure, indicate a problem. Some researchers believe it could be better used as a screening test to catch chronic diseases earlier.

“You get quite a lot of lean men with no other risk factors, no cholesterol, nothing else, but they have an elevated CRP, which would suggest that they’re doing something wrong,” says Egger.

Others argue that as a non-specific, overly-sensitive test, it’s largely unnecessary. “Because it’s non-specific, it’s a double-edged sword,” says Dr Steve Hambleton, director of the Australian Medical Association. “If it comes back negative, everyone goes, ‘that’s good, you haven’t got cancer, you haven’t got inflammation’. If it’s positive, then you’re faced with ‘what the heck is causing it?’.”

If you want to get tested, make sure you’re healthy on the day, as it picks up all inflammation in your body, even minor cuts. You may need more than one test to be sure your CRP is elevated. Your reading should fall under 1mg/L. If it’s above three, your heart-attack risk doubles.